Abstract
Antifungal susceptibility testing methods currently lack a standardized procedure. Many factors, such as inoculum preparation, inoculum density, medium selection, pH, incubation time and temperature, and endpoint determination, affect results. We developed a workable procedure for fungal susceptibility testing, with a microtiter method based upon modifications of the proposed guidelines from the National Committee for Clinical Laboratory Standards, using two different growth media. For this procedure, the microtiter tray is prepared as a panel of 6 drugs (amphotericin B, flucytosine, fluconazole, ketoconazole, miconazole, and itraconazole) alone and in combination with amphotericin B. Eagle's minimal essential medium and RPMI 1640 are the two growth media. Two separate susceptibility trays are inoculated for each sensitivity test, with one tray incubated at 30 degrees C and the other incubated at 35 degrees C. After 48 h of growth, results for both temperatures and both media are recorded and interpreted. The four test environments (two media each at two temperatures) provided growth for 100 of the first 104 organisms that were submitted for testing. This approach provides a workable methodology for routine antifungal susceptibility testing in a clinical microbiology laboratory setting.
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- Barchiesi F., Colombo A. L., McGough D. A., Fothergill A. W., Rinaldi M. G. In vitro activity of itraconazole against fluconazole-susceptible and -resistant Candida albicans isolates from oral cavities of patients infected with human immunodeficiency virus. Antimicrob Agents Chemother. 1994 Jul;38(7):1530–1533. doi: 10.1128/aac.38.7.1530. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bindschadler D. D., Bennett J. E. A pharmacologic guide to the clinical use of amphotericin B. J Infect Dis. 1969 Oct;120(4):427–436. doi: 10.1093/infdis/120.4.427. [DOI] [PubMed] [Google Scholar]
- Brajtburg J., Powderly W. G., Kobayashi G. S., Medoff G. Amphotericin B: current understanding of mechanisms of action. Antimicrob Agents Chemother. 1990 Feb;34(2):183–188. doi: 10.1128/aac.34.2.183. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Francis P., Walsh T. J. Evolving role of flucytosine in immunocompromised patients: new insights into safety, pharmacokinetics, and antifungal therapy. Clin Infect Dis. 1992 Dec;15(6):1003–1018. doi: 10.1093/clind/15.6.1003. [DOI] [PubMed] [Google Scholar]
- Galgiani J. N. Susceptibility testing of fungi: current status of the standardization process. Antimicrob Agents Chemother. 1993 Dec;37(12):2517–2521. doi: 10.1128/aac.37.12.2517. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hughes C. E., Harris C., Moody J. A., Peterson L. R., Gerding D. N. In vitro activities of amphotericin B in combination with four antifungal agents and rifampin against Aspergillus spp. Antimicrob Agents Chemother. 1984 May;25(5):560–562. doi: 10.1128/aac.25.5.560. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jones R. N., Edson D. C. Antibiotic susceptibility testing accuracy. Review of the College of American Pathologists Microbiology Survey, 1972-1983. Arch Pathol Lab Med. 1985 Jul;109(7):595–601. [PubMed] [Google Scholar]
- Pfaller M. A., Barry A. L. Evaluation of a novel colorimetric broth microdilution method for antifungal susceptibility testing of yeast isolates. J Clin Microbiol. 1994 Aug;32(8):1992–1996. doi: 10.1128/jcm.32.8.1992-1996.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pfaller M. A., Rinaldi M. G. Antifungal susceptibility testing. Current state of technology, limitations, and standardization. Infect Dis Clin North Am. 1993 Jun;7(2):435–444. [PubMed] [Google Scholar]
- Rex J. H., Pfaller M. A., Rinaldi M. G., Polak A., Galgiani J. N. Antifungal susceptibility testing. Clin Microbiol Rev. 1993 Oct;6(4):367–381. doi: 10.1128/cmr.6.4.367. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rex J. H., Rinaldi M. G., Pfaller M. A. Resistance of Candida species to fluconazole. Antimicrob Agents Chemother. 1995 Jan;39(1):1–8. doi: 10.1128/aac.39.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Roberts N. J., Jr Temperature and host defense. Microbiol Rev. 1979 Jun;43(2):241–259. doi: 10.1128/mr.43.2.241-259.1979. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Werner E., Seibold M., Antweiler E. Susceptibility testing of Candida species for fluconazole: the role of buffering in the agar dilution assay. Mycoses. 1993 Mar-Apr;36(3-4):125–130. doi: 10.1111/j.1439-0507.1993.tb00699.x. [DOI] [PubMed] [Google Scholar]
- White A., Goetz M. B. Azole-resistant Candida albicans: report of two cases of resistance to fluconazole and review. Clin Infect Dis. 1994 Oct;19(4):687–692. doi: 10.1093/clinids/19.4.687. [DOI] [PubMed] [Google Scholar]